I had a risky exposure with a commercial sex worker. She asked if I was ok with lambskin condom, she said she was allergic to latex . I was unaware of the difference and I unknowingly said yes so I basically had unprotected vaginal sex with her  (I am a heterosexual male, uncircumcised)

I had a number of tests which all came out negative

1) HIV 1 RNA, QL REAL TIME PCR . I did this at the 12th day and 31st day and both were negative

[Links deleted]

From google searching the symptoms (I know this is not encouraged) I found this looks similar to palmar erythema. I am wondering if somehow my tests missed the hiv in my body due to some underlying immune issue and I suddenly started doubting my test results . I wanted your opinion on this. 

This really wasn't a particularly risky exposure. In the US and other industrialized countries, the large majority of female sex workers do not have HIV. In the US, generally around one in a thousand, sometimes as high as 1 in a hundred (1%). Second, it is wrong to assume that natural membrane condoms are unsafe. Any barrier is a lot better than none, and to my knowledge there have been no reports of HIV or any other STI that appeared to be acquired because a natural membrane versus latex or polyurethane condom. This sexual exposure was essentially zero risk for HIV. (As a side note, however, I'll point out that your CSW partner needn't rely upon natural membrane condoms; she could use polyurethane condoms instead of latex.)

Even if this had been truly high risk -- for example, entirely unprotected vaginal sex -- you really didn't need so many HIV tests. In any case, your negative results are 100% reliable. In theory, 45 days would be very slightly more reliable than 41 days for the AgAb blood tests. However, the combination of negative RNA PCR at 12 and 31 days plus negative antibody at 30 days or more is 100% conclusive.

Therefore, there is no possibility that your skin rash is due to HIV -- and in any case your description doesn't suggest an HIV infection. If it looks like palmar erythema, that's probably what you have. We do not examine posted photos: we and ASHA, the forum sponsor, consider this to be practicing medicine from a distance, which we cannot do (which is described in the FAQs). Sorry about that, but I have also deleted the links to your photos so they won't be available to other forum users. Anyway, the lab test results overrule the exposure history and any and all symptoms people may have:  even with a truly high risk exposure and/or very typical symptoms of ARS, a negative test result is to be trusted.

The bottom line is that you can be sure you didn't catch HIV. No more testing is needed, and if you have a regular sex partner, you can continue your normal sex life without any risk of transmission.

I hope this information is helpful. Let me know if anything isn't clear.

HHH, MD

Thanks